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Abstracts of Poster and e-Poster Presentations
PA-450 Laboratory diagnosis of Pneumocystis jirovecii in HIV-positive infants with severe pneumonia using non-invasive samples
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  1. Alfeu Passanduca1,
  2. Franklyn Nkongho2,
  3. Uneisse Cassia1,
  4. Muhammad Sidat1,
  5. Sónia Martins1,
  6. Elias Manjate1,
  7. Celda Mavume3,
  8. Amir Seni3,4,
  9. Kajal Chhaganlal4,
  10. Atija Salimo5,
  11. Merunissa Gafur6,
  12. Laize Beca5,
  13. Armando Saide5,
  14. Joseph Borrell7,
  15. Shannon Richardson7,
  16. Karin Nielsen-Saines7,
  17. Justina Bramugy8,
  18. Sheila Fernández-Luis8,9,
  19. Quique Bassat8,9,
  20. Matthew Bates2,
  21. Alfredo Tagarro10,11,12,
  22. Cinta Moraleda10,13,
  23. Pablo Rojo13,14,
  24. Jahit Sacarlal1,
  25. W Chris Buck1,7
  1. 1Universidade Eduardo Mondlane Faculdade de Medicina, Mozambique
  2. 2Department of Life Sciences, University of Lincoln, UK
  3. 3Hospital Central de Beira, Mozambique
  4. 4Universidade Católica de Moçambique Faculdade de Ciências de Saúde, Mozambique
  5. 5Universidade Lúrio, Mozambique
  6. 6Hospital Central de Nampula, Mozambique
  7. 7University of California Los Angeles, David Geffen School of Medicine, USA
  8. 8Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
  9. 9ISGlobal, Hospital Clínic - Universitat de Barcelona, Spain
  10. 10Foundation for Biomedical Research of the Hospital Universitario 12 de Octubre-Hospital 12 (FIBH12O), Paediatric Unit for Research and Clinical Trials (UPIC), Spain
  11. 11Universidad Europea de Madrid, San Sebastian de los Reyes, Spain
  12. 12Servicio Madrileño de Salud (SERMAS), Infanta Sofia Hospital, San Sebastian de los Reyes, Spain
  13. 13Servicio Madrileño de Salud (SERMAS), 12 de Octubre University Hospital, Spain
  14. 14Universidad Complutense. Spain

Abstract

Background The laboratory diagnosis of P. jirovecii pneumonia (PCP) is typically based on microscopic observation of cysts and trophic forms on deep respiratory specimens. In low-income countries, access to bronchoalveolar lavage is limited, particularly for children, and PCP is usually a clinical diagnosis in HIV-positive infants. The use of different laboratory tests on more easily-obtained upper respiratory and venous blood samples could enhance laboratory-confirmed PCP diagnosis.

Methods PCP-PED is an ongoing ancillary-study of the EMPIRICAL trial (#NCT03915366), supported by the EDCTP2 Program and the European Union (TMA2020CDF-3217), which recruits HIV-positive infants hospitalized with severe pneumonia from 8 hospitals in Mozambique. Nasopharyngeal aspirates are processed for direct immunofluorescence microscopy (IFM) to detect P. jirovecii cysts and for quantitative polymerase chain reaction (qPCR) targeting kex-1 gene (Genesig real-time PCR kit). Plasma samples will be used for serologic quantification of (1–3)-β-D-glucan (BG) and Human Krebs Von Den Lungen-6 (KL-6) antigens.

Results In interim analysis as of March 2023, 61/151 (40.4%) participants recruited have qPCR and IFM results. Median age was 4.0 [IQR, 3.1–6.3] months and 47.5% (29/61) were female. Median HIV viral load and CD4% were 6.0 logs cp/mL [IQR, 5.9 -6.9] and 13.5% [IQR, 10.0–19.6], respectively. qPCR was positive in 45.9% (28/61) and 39.3% (11/28) were on cotrimoxazole prophylaxis prior to hospitalization. The median P. jirovecii fungal load on positive samples was 13,304 copies/mL [IQR, 3,975–61,484]. Among participants with positive qPCR, 25% (7/28) were IFM positive. All participants with negative qPCR results were IFM negative; no participants with positive IFM had negative qPCR results.

Conclusion Positivity rates for qPCR were higher than for IFM, suggesting superior sensitivity for P. jirovecii detection. Future analysis will focus on qPCR/IFM correlation, BG and KL-6 results, and P. jirovecii PCR fungal loads to attempt to differentiate colonization and infection.

https://doi.org/10.1136/bmjgh-2023-EDC.203

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